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Shin Splints: Causes, Treatment & How to Get Back to Running Stronger

Shin Splints: Causes, Treatment & How to Get Back to Running Stronger

by | Nov 27, 2019 | Ankle and Foot, Return to Sport, Running Injuries, Sports Injury

Key Takeaways

  • Shin splints (MTSS) are an overuse bone stress injury.

  • Training load errors are the biggest contributor.

  • Hip strength and force control play a major role.

  • Early management prevents stress fractures.

  • Strength + smart loading beats rest alone.

    Mid Potion Achilles Tendinopathy Location

    Shin Splints

    Shin splints, known in the research as medial tibial stress syndrome (MTSS) are one of the most common running injuries we see at Praxis Physiotherapy across our Teneriffe, Buranda and Carseldine clinics.

    If you’re noticing a dull ache along the inside of your shin that worsens with running, skipping or sport, you’re not alone. The good news? With the right plan, shin splints are highly manageable — and preventable.

    Let’s break down what’s actually happening, why it develops, and what you can start doing today.

    What Are Shin Splints (Medial Tibial Stress Syndrome)?

    Shin splints are an overuse bone stress injury affecting the inner (medial) border of your tibia (shin bone).

    What does it feel like?

    • Aching pain along the lower inside shin

    • Sharp pain when running or jumping

    • Tenderness to touch along the bone

    • Morning stiffness or pain when first starting activity

    Unlike a stress fracture (which is more focal and severe), shin splints usually present as a broader area of tenderness along the bone.

    What’s Actually Happening? (The Pathology Explained Simply)

    MTSS is no longer thought to be just an “inflammation” problem.

    Current evidence suggests shin splints develop due to repetitive loading that exceeds the bone’s capacity to adapt. When running loads increase too quickly, the tibia experiences repeated bending stress. If recovery isn’t adequate, this leads to:

    • Bone stress reaction

    • Irritation of the periosteum (bone lining)

    • Localised pain along the medial tibia

    If ignored, MTSS can progress to a tibial stress fracture, which requires significantly longer time away from running.

    That’s why early management matters.

    Why Do Shin Splints Develop?

    A large systematic review by Winkelmann et al. (2016) identified over 100 potential risk factors for MTSS, with several consistently seen in clinical practice.

    Key Risk Factors Supported by Research

    1. Training Load Errors
    Rapid increases in running volume, intensity, or frequency are one of the strongest contributors.
    (Winters et al., 2013; Nielsen et al., 2012)

    2. Higher Body Mass Index (BMI)
    Greater body mass increases tibial loading forces.

    3. Biomechanical Factors

    • Increased navicular drop (foot pronation)

    • Greater plantarflexion range

    • Hip muscle weakness and poor pelvic control

    4. Previous History of MTSS
    Recurrence risk is higher without proper rehabilitation.

    Importantly flat feet alone are rarely the sole cause.

    What we often see clinically is this chain reaction:

    Poor hip control → knee collapses inward → foot over-pronates → increased traction stress on medial tibia.

    The foot is often the victim, not the culprit.

    Why Rest Alone Isn’t Enough

    Yes — rest reduces pain. But rest does not improve:

    • Load tolerance

    • Running capacity

    • Strength deficits

    • Movement control

    This explains why shin splints are common in recreational runners but less frequent in well-structured training programs. Higher-level athletes typically follow progressive loading plans that allow bone and tendon adaptation.

    Research consistently supports graded loading and strengthening as key components of recovery (Moen et al., 2012).

    .

    How to Manage Shin Splints (Early Stage Tips)

    If your symptoms are mild to moderate, here are evidence-informed starting points:

    1️⃣ Relative Rest (Not Complete Rest)

    Reduce running volume by 30–50%.
    Avoid sharp increases in load.
    Swap some runs for cycling or swimming temporarily.

    2️⃣ Strengthen the “Shock Absorbers”

    Focus on:

    • Calf strength (bent and straight knee)

    • Tibialis posterior strengthening

    • Glute medius and hip control exercises

    • Single-leg stability work

    Improving hip strength can reduce tibial loading by improving force control through the limb.

    3️⃣ Manage Running Workload

    Follow the “10% rule” cautiously.
    Allow recovery days between harder sessions.
    Avoid sudden terrain changes (e.g., grass → concrete).

    4️⃣ Consider Footwear

    Ensure shoes are not worn out (>600–800km).
    Orthotics may help some individuals — but only after assessment.

    When Should You See a Physio?

    Seek professional assessment if:

    • Pain persists longer than 2–3 weeks

    • Pain becomes sharp and localised

    • Hopping on one leg is painful

    • Symptoms worsen despite reducing load

    Early intervention reduces the risk of progression to stress fracture.

    How Praxis Approaches Shin Splints

    At Praxis, we don’t treat “shin splints.”
    We treat your specific loading problem.

    Your plan may include:

    ✔ Comprehensive running and strength assessment
    ✔ Individualised load management plan
    ✔ Targeted strength and control program
    ✔ Manual therapy where appropriate
    ✔ Gradual return-to-run progression
    ✔ Prevention strategy for long-term performance

    Because no two runners load the same way, and no two recovery plans should be identical.

    If you’re dealing with shin splints, or want to prevent them from coming back, our team can help.

    Book an in-depth running and lower limb assessment today.

    📍 Clinics in Teneriffe, Buranda & Carseldine
    📞 (07) 3102 3337
    💻 Book online

    💪 Trusted by athletes. Backed by evidence. Here for everyone.

    The Praxis Team.

    PREVENT | PREPARE | PERFORM

    References

    • Winkelmann ZK et al. (2016). Risk factors for medial tibial stress syndrome in active individuals. Journal of Athletic Training, 51(12), 1049–1052.

    • Winters M et al. (2013). Medial tibial stress syndrome: a critical review. Sports Medicine, 43(12), 1315–1333.

    • Moen MH et al. (2012). Treatment of medial tibial stress syndrome: a systematic review. Sports Medicine, 42(11), 965–981.

    • Nielsen RO et al. (2012). Training errors and running-related injuries. International Journal of Sports Physical Therapy, 7(1), 58–75.

     

    Images:

    The above images are owned by the “Trainer Academy (https://traineracademy.org/) ” and used in this article with thanks.

    References:

    1. Hopper D, Deacon S, Das S, et al. Dynamic soft tissue mobilization increases hamstring flexibility in healthy male subjects. Br J Sports Med. 2004;39:594–598
    2. Weerapong, P., Hume, P.A. & Kolt, G.S. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med 2005; 35: 235
    3. Morelli M, Seaborne DE, Sullivan SJ. Changes in h-reflex amplitude during massage of triceps surae in healthy subjects.J Orthop Sports Phys Ther. 1990;12(2):55-9.
    4. Arroyo-Morales M1, Fernández-Lao C, Ariza-García A, Toro-Velasco C, Winters M, Díaz-Rodríguez L, Cantarero-Villanueva I, Huijbregts P, Fernández-De-las-Peñas C. Psychophysiological effects of preperformance massage before isokinetic exercise. J Strength Cond Res. 2011 Feb;25(2):481-8.

    https://www.massagemyotherapy.com.au/Home

    Fact or Fiction – Strength Training

    Fact or Fiction – Strength Training

    by | Nov 15, 2019 | Uncategorized

    I’ve been doing my exercises for two weeks religiously and I’m no stronger! This will never work!

    ANSWER: Fiction

    How long does it take to have strength gains? The answer is actually in two parts. Increasing muscle size (hypertrophy) takes a minimum of 6 weeks, and repetitive exposures to fatiguing loads. BUT, neural adaptations can occur over the first 1-2 weeks.

    What the heck is neural adaptations? Imaging you have a small car battery trying to start a truck. It will struggle to do a good job again and again and fade easily. Now try using 10 of those same smaller batteries, which makes the engine start easier. A similar type of thing happens with our nervous system as we train. We become much more efficient with our neural firing to the muscle.

    As you can see in the picture below, you have a long way to go in your strengthening after those first two weeks. That is often why we often need to see beyond when the pain goes away as we know that there is so much more work to be done!

    If you have been troubled by niggles and pains, don’t hesitate to contact us to ensure we can help you prevent prepare perform! Book online or call us on (07) 3102 3337.

    #factorfictionfriday #praxisphysio #physioeducation #knowledgeiskey

    Sale, D. G. (1988). Neural adaptation to resistance training. Med Sci Sports Exerc, 20(5 Suppl), S135-145. doi:10.1249/00005768-198810001-00009

    Is running bad for your knees?

    Is running bad for your knees?

    by | Nov 28, 2018 | Knee, Pain, Return to Sport, Running Injuries, Sports Injury

    Running. Probably one of the most maligned exercises when it comes to knees and overuse injuries. The thought that running ‘wears’ out your knees and causes osteoarthritis (a chronic disease often associated with joint pain and stiffness, reduced mobility and reduced quality of life) is one of the most common comments I hear as a physiotherapist – typically by non-runners. But do we have it right? Is running actually bad for your knees?

    I recently attended the University of Queensland Sports Masters presentation day. The keynote speaker was a Dr Jean-Francois Esculier, a Postdoctoral Fellow at the University of British Columbia on the topics of running and knee osteoarthritis. Originally trained as a physiotherapist, Dr Esculier gave us an excellent overview of his latest research his take on whether or not running is detrimental to knee health.

    First, there was an acknowledgement that echoed the sentiments in the opening paragraph. A study in which Dr Esculier undertook attempted to ascertain the perception about running and the knee joint health among the public and health care professionals. The results suggested that many non-runners perceived running as detrimental to knee health. Understandably, with no clear guidelines, health care professionals displayed high rates of uncertainty regarding running as a risk factor to develop knee osteoarthritis (KOA), and about the appropriateness of running with pre-existing KOA [1].

    Mid Potion Achilles Tendinopathy Location

    Osteoarthritis often results in cartilage loss, in bone rubbing on bone, which can cause inflammation, pain, stiffness, reduced mobility and reduced quality of life [7].

    The paucity of clear training parameters for runners also has a knock on effect with a staggering 75% of runners report being injured whilst running each year with the knee being the most common region of complaint [2]. From my experience as a clinician, the factor that is most often associated with an injury are training errors. Too much too quick. Boom bust. No physical preparation. No listening to your body or allowing adequate recovery time. No periodisation or plan – just run and run.

    The remainder of the talk that covered many interesting relatable topics (that will likely be areas for future blogs) but the information that most interested me and should answer the question as to whether running is bad for your knees was the following:

    Cartilage change with running:

    With the improvements in MRI scanning, more papers are looking at the cartilage volume of knees immediately after a long distance run. According to current evidence [3], cartilage may exhibit short-term decreases in thickness, volume and cartilage water flow (T2 relaxation time) secondary to temporary loss of fluid following repeated compressions associated with running. However, cartilage size tends to return to baseline within hours suggesting that cartilage may well tolerate mechanical loading sustained during running and adapt to repeated exposure.

    The response of cartilage to longitudinal load is exactly what Van Ginckel et al [4] investigated. After providing a 10 week “Start To Run” program to novice runners, the reserachers looked at the glycosaminoglycan (GAG) content before and after the running intervention and compared to sedentary controls, who did no running. For those of you (like me) who had no idea what glycosaminoglycan / GAG content is, it is essentially a surrogate marker for cartilage quality (specifically, GAG is an important structural matrix compound in regulating the cartilage tissue’s endosmotic swelling pressure and thus, the tissue’s compressive strength).

    The results suggested that a gradually built up running scheme appears to positively effect GAG content, and thus cartilage quality. In fact, running appears to be a chondroprotective effect on the knee when compared to a sedentary lifestyle in a female asymptomatic subjects. The author’s went onto say that running schemes like this might be considered a valuable tool in osteoarthritis prevention strategies [4].

    Osteoarthritis (OA) rates in competitive vs recreational vs non-runners:

    The body’s ability to adapt to considered and appropriate load is likely explanation as to why when we look at the rates of lower limb osteoarthritis (OA) across the population, we find some interesting results. A systematic review [5] of the literature looked at the association of recreational and competitive running with hip and knee OA. The overall prevalence of hip and knee OA was 13.3% in competitive runners, 3.5% in recreational runners, and 10.2% in controls. Exposure to running of less than 15 years was associated with a lower association with hip and/or knee OA compared with non-runners.

    Recreational runners had a lower occurrence of OA compared with competitive runners and controls. These results indicated that a more sedentary lifestyle or long exposure to high-volume and/or high-intensity running are both associated with hip and/or knee OA. However, it was not possible to determine whether these associations were causative or confounded by other risk factors, such as previous injury [5].

    SUMMARY

    Running appears not to cause osteoarthritis in your knees unless you are a competitive long distance runner. Even then, you are only slightly above the average for non-runners but enjoy the myriad of other benefits that exercise brings. Further, increased mileage in recreational runners appears to be actually protective for your knees and reduces your risk of needing a knee replacement [6]. Caution however must be taken to monitor detailed training parameters such as frequency, speed and distance, so that an optimal dosage for knee joint health tailored to the individual patients with knee osteoarthritis.

    So the next time someone tells you that you shouldn’t be running because you’ll get OA, or if your health expert recommends to stop all activity because you have been diagnosed with mild / moderate osteoarthritis of the knee, we can help! As always, we at Praxis are more than happy to help you navigate your way back to performing – whatever that may look like! Give us a call (07) 3102 3337 or book online www.praxisphysio.com.au today

    Until next time, Praxis What You Preach

    There is no need to accept knee pain as ‘normal’. Call us now on (07) 3102 3337 or book online to have one of our physios develop a plan to reduce your pain and restore your function!

    To read more about how running can help your knees (that’s right – running!) check out our related posts on running written by our published principal physio, Stephen.

    Team Praxis,

    PREVENT | PREPARE | PERFORM